A caretaker for a senior with CLL is
often much more than a conduit to appointments and drugs. Many caregivers want
to know why a particular drug is being prescribed, what other options there are
and how the various treatments will impact the person with CLL in their daily
lives.
There are many new treatments being given
to people with CLL. Many of these are being used as targeted treatments. They
may be used alone or in various combinations, depending on the patient and
disease characteristics. Despite availability of multiple new treatments, there
are many factors that must be taken into consideration to choose the
appropriate treatment option.
Chronic Lymphocytic Leukaemia or CLL is a
form of blood cancer characterized by presence of abnormal lymphocytes. These
are a type of white blood cells which, in people with CLL, slowly start to
multiply in the blood, in the bone marrow where all the blood cells are
produced, and in the lymphatic system of tissues and organs throughout the body.
It tends to develop in middle aged or older people.
However, the majority of individuals with
CLL are asymptomatic at the time of diagnosis and are therefore monitored on an
active surveillance or watchful waiting basis until such time as the disease
progresses and requires treatment.
In summary, while there are times when
CLL needs to be treated, there are also times when regular monitoring is
enough. When there are signs of progression, or symptoms, then treatment may be
indicated. At that time, enlarged lymph nodes, and low blood counts, as well as
fatigue, night sweats, unexplained weight loss, and fever, can be symptoms
which indicate the need for treatment.
Two people of the same age have very
different physical, mental, social and financial circumstances. Hence treatment
decisions are based on more than age of patient.
For an older adult, clinicians may
consider:
●
Overall physical health and
functional ability
●
Other medical conditions and
medications
●
Kidney and liver function
●
Blood-cell counts
●
CLL stage and rate of progression
●
Genetic findings, including TP53
abnormalities and del(17p)
●
Previous CLL treatment
●
Risk of infections and other
treatment-related complications
●
The person's preferences and
ability to manage treatment
Geriatric assessment is done to evaluate
physical function, cognitive status, nutrition and social support to aid cancer
treatment decisions.
The assessment for a geriatric patient
with CLL will likely differ greatly from that of a younger patient with the
same diagnosis. The results can help the patients and caregivers in evaluating
treatment options.
Treatment for CLL is increasingly moving
towards targeted therapy using a medicine that in turn uses a particular
protein to kill CLL cells.
The Bruton tyrosine kinase (BTK)
inhibitors are a class of targeted therapy for CLL.
Examples include:
●
Acalabrutinib
●
Zanubrutinib
●
Ibrutinib
These types of therapies can inhibit the
BTK protein and other related proteins which affect the B-cell in terms of
development and in the CLL cell in terms of survival.
Additionally, while latest CLL treatments are
administered via oral tablets or subcutaneous injection rather than via an IV
line and infused into a vein over hours, these novel oral therapies can cause
significant side effects and have drug-drug and drug-food interactions,
requiring the monitoring of such issues as the patient’s blood counts, cardiac
function, risk of bleeding, risk of infection, and other treatment-related
adverse effects.
Venetoclax is a BCL-2 targeted therapy.
BCL-2 is a protein that certain cancer cells use to survive. The most common
use of Venetoclax in CLL is in combination with other therapies such as
obinutuzumab and rituximab.
Venetoclax is being given in a new manner
in order to decrease the risk of developing TLS (Tumor Lysis Syndrome) during
the early dose-escalation period of treatment. Normal laboratory values and
gradually increasing doses of venetoclax will be a cornerstone of its early
administration.
Caregivers should be especially vigilant
in following a treatment plan that involves a monitoring schedule for a
treatment like venetoclax.
The CLL treatment landscape has evolved
significantly in recent years. For example, in February 2026 the U.S. Food and
Drug Administration approved acalabrutinib in combination with venetoclax for
CLL treatment.
Targeted treatments are designed as per
patient and disease characteristics. Approval of a combination of cancer drugs
by the FDA does not automatically mean that it will be the an appropriate
treatment option for a particular patient with CLL. Rather, it will be one of
the many considered for an individual patient on the basis of their disease,
medical history, other drugs that they are taking, how they tolerate individual
drugs, and their preferences.
Even after treatment has seemingly been
effective, CLL can return at a later time, and treatment options that are
relevant for patients with relapsed CLL are largely based on the prior
treatments that have been used.
Pirtobrutinib is a non-covalent BTK
inhibitor. Recently, pirtobrutinib was approved by the FDA for the treatment of
adults with CLL or SLL who have had prior treatment with a covalent BTK
inhibitor.
There are many other treatments,
including new targeted therapies and treatment combinations, that are being
investigated for patients with CLL that has become resistant to treatment.
These are often investigated in the context of a clinical trial.
Just as every person with CLL is
different, so too is every person’s CLL. The differences can be in terms of the
individual’s prognosis and in terms of the choices for treatment. Certain
genetic and molecular features of the cancer can affect both.
Among the key findings that can guide
treatment decisions for CLL patients are TP53 abnormalities and deletion 17p
(del(17p)). These can mark a more aggressive disease that is harder to treat
with standard CLL therapies.
A patient’s genetic makeup can influence
treatment options during the treatment, or even before starting the treatment.
Caregivers play a vital role for elderly
patients during treatment for CLL and can monitor for changes and report to
clinicians if needed.
Depending on the treatment, clinicians
may monitor:
●
Blood-cell counts
●
Signs of infection
●
Bleeding or bruising
●
Heart-related symptoms
●
Kidney function
●
Liver function
●
Medication interactions
●
Treatment-related fatigue or other
side effects
A list of the patient’s prescription
medicines, over-the-counter products, and supplements can be maintained by
caregivers. These can potentially cause an interaction with the treatment of
the patient.
Caregivers must report new or unusual
symptoms to the treating healthcare team.
Useful questions for the CLL Care Team
appointment.
●
Does the CLL currently require
treatment?
●
What is the goal of treatment?
●
Which treatment options are
appropriate for this patient?
●
What test results influenced the
treatment recommendation?
●
Has genetic testing been
performed?
●
What side effects should the
family watch for?
●
Which symptoms require urgent
medical attention?
●
Are there interactions with the
patient's existing medicines?
●What should be the frequency
of blood work check and monitoring?
●
Are clinical trials appropriate?
Written notes can also be helpful to
record information that the family needs to remember in order to follow the
instructions given by the CLL Care Team, as well as remembering the dates and
times of the family’s and patient’s future appointments for treatment and
check-ups.
Finally, CLL care includes more than
leukemia control. Patients, especially of advanced age, often suffer from a
variety of problems including frequent infections, decreased appetite and
subsequent weight loss, extreme tiredness, depression, decreased mobility, and
other co-existing health problems.
Supportive care to treat symptoms and
problems of CLL can vary greatly from person to person. The caregiver
needs to report any change in the patient’s physical condition or in their
daily functioning, such as loss of appetite, or lack of energy, etc.
Current CLL treatments include targeted
therapies, BTK inhibitors, and venetoclax-based combinations, as well as newly
approved treatments for relapsed or refractory CLL, such as new agents for
previously treated patients like pirtobrutinib, which was recently granted a
traditional approval for a specific subset of previously treated CLL patients.
For older adults, the most appropriate
treatment depends on individual patient and disease characteristics and may not
necessarily be the latest treatment option. Individualized management of CLL,
taking into consideration the patient’s specific leukemia, previous treatment,
other health problems, other current diseases, potential drug toxicities and
patient preferences is typical.
These forms of support can help
caregivers play an active role throughout the treatment process
Medical disclaimer: The purpose of this article is for general information and for
education purposes only. The CLL treatment of individual patients has to be
decided by their qualified healthcare providers after thorough examination of their
disease, overall health, as well as other coexisting medical conditions.
As we age, staying socially connected can become just as important as staying physically active. Friendships, family relationships, community involvement, and regular social activities can bring joy and purpose to everyday life.Retirement and other life changes can sometimes reduce opportunities for social interaction. Children may live farther away, friends may move or pass away, and health or mobility changes may make it harder to participate in activities outside the home.For these reasons, finding meaningful ways to stay connected is an important part of healthy aging. Social connection can support emotional well-being, encourage an active lifestyle, and help seniors continue to feel a strong sense of belonging.Social Connection Can Help Reduce LonelinessLoneliness can affect anyone, but older adults may experience changes in their social networks as they age. Spending too much time alone can leave a senior feeling disconnected from family, friends, and the community around them.Regular social interaction provides opportunities to talk, laugh, share experiences, and simply enjoy another person's company.Even simple activities such as having coffee with a friend, eating a meal with others, attending a group activity, or taking a walk together can help a senior feel more connected.Friendships Give Seniors a Sense of BelongingFriendships remain important throughout life. Having people to talk with and share experiences with can provide comfort and companionship.Senior living communities can provide opportunities to develop new friendships while maintaining existing relationships. Shared meals, social gatherings, clubs, classes, and recreational activities give residents natural opportunities to meet people with similar interests.Making new friends can help a senior feel that they are part of a community rather than living in isolation.Social Activities Can Provide a Sense of PurposeHaving something to look forward to can make a meaningful difference in a person's daily life. Social activities give seniors opportunities to participate, contribute, and remain involved.For example, a senior might: Volunteer in the community Participate in a hobby group Attend an educational class Help organize an activity Join an exercise or walking group Enjoy music, games, or crafts with others Participate in community events These activities can provide structure while encouraging seniors to continue exploring their interests.Staying Connected Can Encourage Physical ActivitySocial interaction and physical activity often go hand in hand. Seniors may be more motivated to take a walk, attend an exercise class, or participate in an outdoor activity when they know friends will be joining them.Being active with others can make exercise more enjoyable and less like a chore.Regular movement is an important part of maintaining strength, balance, mobility, and independence as we age. Social activities that incorporate movement can provide both physical and social benefits.Social Engagement Keeps the Mind ActiveConversations, games, classes, hobbies, and other social activities can provide opportunities for seniors to think, learn, communicate, and solve problems.Trying something new or participating in a discussion with others can help keep everyday life interesting and mentally stimulating.Lifelong learning can also be an enjoyable way for older adults to meet people while exploring new interests or continuing to develop existing ones.Family Connections Remain ImportantWhile friendships and community involvement are valuable, family relationships can also provide an important source of social connection.Regular phone calls, video chats, visits, shared meals, and family activities can help seniors maintain close relationships with children, grandchildren, siblings, and other loved ones.When family members live nearby, visiting in person can be especially meaningful. When distance makes regular visits difficult, technology can help families stay connected between visits.Senior Living Communities Can Create Opportunities for ConnectionOne benefit of a senior living community is the opportunity to live among other people in a similar stage of life.Instead of having to arrange every social interaction, seniors may have activities and opportunities for connection close to home. Dining areas, common spaces, walking paths, fitness programs, educational opportunities, clubs, and community events can make socializing a natural part of daily life.Residents can choose the level of participation that feels right for them. Some may enjoy a busy schedule filled with activities, while others may prefer smaller gatherings and quiet conversations with friends.Staying Connected Can Help Seniors Maintain IndependenceSocial connection is also part of maintaining an active and fulfilling lifestyle. Seniors who remain engaged with others may be more likely to continue participating in hobbies, community activities, exercise, and other interests.Having friends and neighbors nearby can also provide an informal support network. Someone may notice when a friend isn't feeling well, offer encouragement, or simply check in after a difficult day.This sense of community can be especially valuable as circumstances change.It's Never Too Late to Build New RelationshipsSome seniors may hesitate to meet new people after moving to a new community or experiencing major changes in their lives. It can take time to feel comfortable in a new environment.Starting small can help. Saying hello to a neighbor, joining one activity, having a meal with others, or attending a class based on a personal interest can be a good first step.Over time, these small interactions can develop into meaningful friendships.How Families Can Encourage Social ConnectionFamily members can play an important role in helping an older loved one remain socially active.Consider encouraging a senior to: Stay in regular contact with family and friends Participate in activities they enjoy Explore new hobbies Attend community events Volunteer when possible Join an exercise or walking group Try a class or educational program Consider a senior living community if living alone has become isolating Most importantly, listen to what the senior wants. Social connection should be meaningful to the individual rather than simply adding more activities to their schedule.A Connected Life Can Be a Fulfilling LifeGrowing older brings many opportunities to enjoy new experiences, relationships, hobbies, and interests. Staying socially connected can help seniors maintain a sense of belonging and purpose while making everyday life more enjoyable.Whether through family, friendships, volunteering, lifelong learning, hobbies, or a senior living community, there are many ways older adults can remain connected.At Landis Homes, opportunities for community, friendship, wellness, learning, and meaningful engagement can be an important part of the senior living experience. Finding the right environment can help older adults continue living an active and connected life while building relationships and enjoying each new chapter.
Staying socially connected is an important part of healthy aging. Spending time with family, talking with friends, attending community events, and participating in hobbies can help seniors maintain meaningful relationships and enjoy a greater sense of purpose.However, hearing loss can sometimes make social activities more difficult. When conversations become challenging to follow, a senior may begin avoiding restaurants, family gatherings, clubs, religious services, or other activities they once enjoyed.The good news is that addressing hearing loss may make it easier for seniors to communicate, participate, and remain connected with the people and activities that matter most.Hearing Loss Can Make Conversations More DifficultOne of the most noticeable effects of hearing loss is difficulty following conversations. This can be especially challenging when several people are talking at once or when there is background noise.A senior may hear that someone is speaking but has trouble understanding the words. They may frequently ask others to repeat themselves or worry that they are responding incorrectly.Over time, these challenges can make everyday conversations frustrating and exhausting.Social Situations Can Become OverwhelmingMany popular social activities take place in environments where hearing clearly can be difficult. Restaurants, family celebrations, community centers, and sporting events may all have background noise that makes conversation harder to understand.Someone experiencing hearing loss may begin to think: "It's too noisy for me to hear." "I don't want to keep asking people to repeat themselves." "I'm afraid I'll miss something important." "It's easier to stay home." When these feelings lead a senior to participate less often, they can gradually become less socially active.Better Hearing Can Make Family Time More EnjoyableFamily relationships are an important source of connection for many older adults. Being able to comfortably hear conversations can make visits with children, grandchildren, siblings, and other loved ones more enjoyable.Better hearing can help seniors participate in conversations instead of simply listening from the sidelines. It can also make it easier to hear grandchildren's stories, enjoy jokes, discuss family news, and stay involved in everyday conversations.These seemingly small interactions can make a big difference in maintaining close relationships.Hearing Can Help Seniors Stay Involved in Their CommunitiesSocial connection extends beyond family. Seniors may have friendships and relationships through volunteer activities, senior centers, clubs, classes, faith communities, exercise groups, or other organizations.When hearing difficulties interfere with participation, a senior may gradually stop attending.Addressing hearing loss may help make these activities more comfortable. Being able to follow conversations and interact with others can encourage seniors to continue participating in the communities they enjoy.Better Hearing May Increase ConfidenceHearing loss can sometimes affect a person's confidence in social situations. A senior may worry about misunderstanding a question, giving an inappropriate response, or missing an important part of a conversation.These concerns can cause someone to become quieter or withdraw from conversations.Improving hearing may provide greater confidence. When seniors can hear and understand what is being said, they may feel more comfortable speaking up, asking questions, and participating in conversations.Staying Socially Active Is Important as We AgeMaintaining social connections can contribute to overall quality of life. Friends and family can provide companionship, encouragement, emotional support, and opportunities to stay engaged with the world around us.Social activities also give seniors opportunities to laugh, share experiences, learn new things, and maintain a sense of belonging.Hearing well can make it easier to take advantage of these opportunities.Hearing Aids May Help Seniors Participate More FullyFor seniors with hearing loss, hearing aids may be one option for improving communication. Modern hearing aids are designed to amplify sounds and can be selected and adjusted based on an individual's hearing needs and lifestyle.A hearing professional can evaluate a person's hearing and discuss whether hearing aids may be appropriate.It is important to remember that hearing aids are not necessarily an instant solution. Seniors may need time to adjust to hearing sounds differently, and follow-up appointments can help ensure that the devices are working comfortably and effectively.Family Members Can Help, TooFamily and friends can make communication easier for someone experiencing hearing loss.Simple changes can include: Getting the person's attention before speaking Facing them during conversations Speaking clearly and at a comfortable pace Reducing unnecessary background noise Moving to a quieter area when possible Avoiding shouting Being patient when something needs to be repeated These strategies can help make conversations more comfortable for everyone.Don't Let Hearing Loss Lead to IsolationHearing loss does not have to mean giving up the activities and relationships a senior enjoys. If communication has become increasingly difficult, it may be time to have hearing evaluated.Some common signs that a hearing evaluation may be helpful include: Frequently asking others to repeat themselves Turning the television volume higher than others prefer Having difficulty understanding conversations in restaurants or groups Struggling to hear on the telephone Feeling that people are mumbling Avoiding social gatherings because hearing is difficult Relying heavily on watching people's faces or lips when they speak Recognizing these signs and seeking professional guidance can be an important first step toward staying socially engaged.Better Hearing Can Help Seniors Stay ConnectedSocial connection is an important part of enjoying life at any age. For seniors experiencing hearing loss, improving communication may make it easier to participate in conversations, spend time with loved ones, maintain friendships, and continue enjoying favorite activities.If you or someone you love is having difficulty hearing, consider scheduling a professional hearing evaluation. Understanding the cause and degree of hearing loss can help determine what options may be available.Darrell M. Sipe Opticians & Hearing Aids is committed to helping patients with their hearing and vision needs. Better hearing can be about much more than hearing sounds, it can help seniors remain involved, confident, and connected to the people and activities that make life meaningful.
Independence is important at every stage of life. For many seniors, being independent means being able to communicate with others, make their own decisions, participate in social activities, manage everyday responsibilities, and continue doing the things they enjoy.Hearing plays an important role in maintaining that independence. When hearing loss goes untreated, everyday communication can become more difficult and frustrating. Over time, some seniors may begin avoiding situations where they have trouble hearing or relying more heavily on family members for help.The good news is that hearing loss doesn't have to mean giving up your independence. Understanding the signs of hearing loss and seeking appropriate hearing care can help seniors stay connected and confident in their daily lives.How Hearing Loss Can Affect IndependenceHearing loss can affect much more than the ability to hear a conversation. It can influence how a senior interacts with family, friends, healthcare providers, coworkers, and members of the community.For example, a senior with hearing loss may have difficulty: Understanding instructions Communicating with healthcare providers Hearing someone at the front door or on the telephone Following conversations in restaurants or other busy environments Participating in group activities Communicating while shopping or running errands Hearing alarms, doorbells, or other important sounds Staying connected with family and friends When these challenges become frustrating, a person may begin relying on others or avoiding certain activities altogether.Hearing Loss Can Make Communication More DifficultCommunication is a major part of independent living.If you frequently have to ask people to repeat themselves or find yourself guessing what someone said, everyday conversations can become tiring.You may also find yourself depending on family members to repeat information or explain what was said during important conversations.Addressing hearing difficulties can make it easier to communicate directly and confidently with the people around you.Staying Connected Is Part of Staying IndependentIndependence doesn't mean doing everything alone. Maintaining relationships and staying involved in your community are also important parts of a fulfilling life.Hearing loss can sometimes cause seniors to withdraw from social activities because they are embarrassed or frustrated when they cannot follow conversations.A person may stop going to restaurants, attending family gatherings, participating in community activities, or visiting friends.Seeking hearing care may make it easier to participate in these activities and maintain the social connections that contribute to a healthy and active lifestyle.Hearing Loss and Healthcare ConversationsClear communication with healthcare providers is especially important for older adults.During medical appointments, seniors may need to understand instructions, ask questions, discuss symptoms, and make decisions about their care.Having difficulty hearing important information can create unnecessary confusion.If you have hearing loss, let your healthcare provider know. Wearing your hearing aids when appropriate, asking people to speak clearly, and choosing a quieter environment can make important conversations easier.Hearing Aids May HelpFor seniors with hearing loss, hearing aids may help improve access to speech and everyday sounds.Modern hearing aids are available in a variety of styles and technology levels. A hearing professional can evaluate your hearing and help determine what type of device may be appropriate for your individual needs.Hearing aids don't necessarily make hearing the same as it was before hearing loss. However, they can help many people hear speech and environmental sounds more easily.The right hearing solution depends on factors such as hearing loss, lifestyle, communication needs, comfort, and personal preferences.Getting Used to Hearing Aids Takes TimeIf you are new to hearing aids, remember that adjusting to them can take time.Sounds may initially seem different or louder than you remember. Your brain needs time to become accustomed to hearing sounds through devices.Work with your hearing professional and follow their recommendations for wearing and caring for your hearing aids. Follow-up appointments can also help address comfort or sound-quality concerns and allow adjustments when needed.Simple Strategies Can Make Communication EasierWhether or not you use hearing aids, there are ways to make everyday communication more successful.Reduce Background NoiseWhen possible, move to a quiet area before having an important conversation. Turning down the television or radio can make it easier to focus on speech.Face the Person SpeakingBeing able to see the speaker's face provides helpful visual information and can make communication easier.Ask People to Speak ClearlyIf you dont understand something, don't be afraid to ask the person to repeat or rephrase it.Be Open About Your HearingLet friends, family members, and healthcare providers know if you have difficulty hearing. Most people are happy to make small adjustments when they understand what you need.Don't Let Embarrassment Stand in Your WaySome seniors avoid talking about hearing loss because they worry that wearing hearing aids will make them appear older or less independent.In reality, taking action to address hearing loss can be a positive step toward maintaining independence.Seeking professional help doesn't mean you are giving up control. It means you are taking an active role in managing your health and finding ways to make everyday life easier.Family Members Can Offer SupportFamily members can play an important role in helping seniors address hearing loss, but the senior should remain involved in decisions about their hearing care.Instead of making decisions for your loved one, encourage them to have their hearing evaluated and learn about their options.Be patient during conversations and avoid shouting. Face them when speaking, reduce background noise, and give them time to respond.Support and encouragement can make it easier for a senior to take the first step toward better hearing.When Should You Have Your Hearing Checked?If you have noticed changes in your hearing, don't wait until communication becomes extremely difficult before seeking help.Consider scheduling a hearing evaluation if you: Frequently ask people to repeat themselves Turn the television volume up higher than others prefer Have trouble hearing in restaurants or groups Struggle to understand conversations on the telephone Feel that people are mumbling Avoid social activities because hearing is difficult Have difficulty hearing important sounds around your home A professional hearing evaluation can help determine whether hearing loss is present and provide information about your options.Protecting Your Independence Starts With Taking Care of YourselfHearing loss doesn't have to prevent seniors from living active, independent lives. Recognizing hearing difficulties and seeking appropriate care can help make communication easier and support continued participation in the activities and relationships that matter most.If you or someone you love is experiencing hearing difficulties, consider scheduling a professional hearing evaluation. Understanding your hearing is the first step toward finding the right solution for your needs.Darrell M. Sipe Opticians & Hearing Aids provides hearing care services to help seniors understand their hearing needs and explore appropriate solutions.Your independence is worth protecting. Don't let untreated hearing loss keep you from communicating, participating, and enjoying the life you want to live.